Exploring the Applications of Indocyanine Green in Robot-Assisted Urological Surgery: A Comprehensive Review of Fluorescence-Guided Techniques

Abstract

This comprehensive review aims to explore the applications of indocyanine green (ICG) in robot-assisted urological surgery through a detailed examination of fluorescence-guided techniques. An extensive literature search was conducted in PubMed/MEDLINE, EMBASE and Scopus, using keywords such as "indocyanine green," "ICG", "NIRF", "Near Infrared Fluorescence", "robot-assisted", and "urology". Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. The integration of the Firefly^® technology in the Da Vinci^® robotic system has opened new avenues for the advancement and exploration of different urological procedures. ICG is a fluorophore widely used in near-infrared fluorescence-guided techniques. The synergistic combination of intraoperative support, safety profiles and widespread availability comprises an additional asset that empowers ICG-guided robotic surgery. This overview of the current state of the art illustrates the potential advantages and broad applications of combining ICG-fluorescence guidance with robotic-assisted urological surgery.

Keywords: ICG; NIRF; firefly; fluorescence imaging; indocyanine green; near-infrared fluorescence; robotic surgery; urology.

Figure 1

ICG-guided Management of Endophytic Renal Tumors: (a) CT-scan showing a totally endophytic left renal tumor; (b) trans-arterial super selective embolization “tagging” with ICG-Lipiodol; and (c) renal tumor intraoperative ICG near-infrared imaging identification.

Figure 2

Trans-nephrostomic Indocyanine-Green-guided Robotic Ureteral Reimplantation for Benign Uretero-Ileal Strictures after Robotic Cystectomy: (a) Alternate use of conventional imaging and NIRF for lumbar ureter identification; (b) NIRF helping in the identification of the ureteral–neobladder junction stricture.